Question of the Week # 129, 130 and 131

Q129] You receive a telephone call from a worried mother. She says her 8 month old son just had a seizure lasting for 2 minutes. The description is generalized tonic-clonic. The seizure has subsided. He is feeding well and acting normally. His temperature is 103F  and RR: 28/min.  The child is not in any distress as per mother. She asks you what needs to be done. The most appropriate response :

A] “Take him immediately to the nearest ER”

B]  “This is nothing serious. You need to stay calm”

C]  “Give antipyretic to the child and monitor the temperature”

D] ” Does anyone in your family have epilepsy?”
Q 130] The patient’s mother in the above question also asks you what is the risk of her child developing a recurrent febrile seizure in future. The most appropriate response :

A] There is no such risk to your child

B] Risk is increased if his family member has a history of febrile seizure

C] He has no increased risk since he is younger than one year

D] He is at increased risk of developing intellectual impairment and neurological deficits.
Q131]  The child’s mother is still very concerned and she has further questions. She asks you, ” Doctor. I am very worried. Does this episode of seizure increase my son’s risk of developing future epilepsy?”
Most appropriate response:

A] Your child had a simple febrile seizure and  is definitely at very high risk of developing epilepsy
B] Your son will be at an increased risk of epilepsy if father has history of febrile seizures.
C] If another seizure occurs during this illness with in 24 hours then he will be at increased risk
D] He will not have increased risk of developing future epilepsy.

12 Responses

  1. 129-c, 130- b, 131c

  2. c,b,c

  3. C-B-D according to Kaplan Notes 2011

  4. This child had a febrile seizure from what has been described but the mother will not play doctor here and prescribe over the counter medication. The physician needs to decide as to wether this is a febrile seizure or there’s more to the story. The infant had a seizure and needs to be monitored at the ER. Moreover, there is no evidence that Acetaminophen or ibuprofen at the onset of fever, phenytoin or midazolam help in preventing a febrile seizure. They DON’T!

    45% of the patients that have a relative with febrile seizures will have a second seizure.

    Febrile Seizures or recurrent febrile seizures are not associated with epilepsy. Patients who have a single febrile seizure have approximately a 2-5% chance of developing a seizure disorder which is the same as the population and they are not @ risk of epilepsy. Children with febrile seizures

    Answers: 129-A, 130-B and 131-D

  5. ABC although initially I thought CBC. The MTB book says you need to evaluate child for meningitis (apart from controlling temp). As for risk of epilepsy, it is increased if :1. atypical seizure-lasts >15min; >1 within 24hrs; focal findings; 2. FHx of epilepsy AND1st seizure before age 9mts; 3. Abnormal development; 4. Preexisting neuro disorder.

    • A,B,C=http://www.mmc.org/workfiles/mmc_bush/Febrile_Seizure_Guideline.pdf

      • Family shouldn’t rule out possible meningitis .so answer is A,B,C= reference see above .

  6. I disagree, I believe it’s ABD, MTB says two seizures within 24hours apart is a risk for epilepsy, IF there is not identifiable cause. The fever is clearly the cause for this patient.

  7. A,B,C

  8. I’m undecided for the first question:

    Option C for the first question because the question stem says the child “is feeding well and acting normally”. If the child was lethargic, fussy – clues of altered mental status – that would be a red flag for the possibility of meningitis. However, the risk may still be there and it’s probably in the patient’s best interest to be taken in and a thorough investigation done (or even just observation by a team of professionals), including a spinal tap if warranted — this then points back at option A.

    B for the second question.

    Third question option D.
    Certain complicating factors can increase the risk for later epilepsy after a febrile seizure. Among them are febrile seizures longer than 15 minutes, febrile seizures in one focal part of the body, multiple febrile seizures within 24 hours or a family history of non-febrile seizures. This infant’s seizure was tonic-clonic, shorter than 15 min, with fever as an identifiable cause.

    • Sorry, forgot to quote:
      http://neurology.stanford.edu/epilepsy/patientcare/videos/e_10.html

      • Okay, first question solved. A 🙂
        A child who has a febrile seizure should be seen by a healthcare provider as soon as possible (in an emergency department or provider’s office) to determine the cause of the fever. Some children, particularly those less than 12 months of age, may require testing to ensure that the fever is not related to meningitis, a serious infection of the lining of the brain.
        http://www.uptodate.com/contents/febrile-seizures-beyond-the-basics

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